Provider Demographics
NPI:1932922622
Name:LANDA, ABEL REYES JR (PTA)
Entity type:Individual
Prefix:
First Name:ABEL
Middle Name:REYES
Last Name:LANDA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14338 DISNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-5037
Mailing Address - Country:US
Mailing Address - Phone:562-712-0191
Mailing Address - Fax:
Practice Address - Street 1:12539 IMPERIAL HWY STE 201
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3106
Practice Address - Country:US
Practice Address - Phone:562-379-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant